Provider Demographics
NPI:1770531758
Name:SANDER, MICHAEL DAVID (MD)
Entity type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:DAVID
Last Name:SANDER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1315 E 6TH ST
Mailing Address - Street 2:STE. 10
Mailing Address - City:WESLACO
Mailing Address - State:TX
Mailing Address - Zip Code:78596-4200
Mailing Address - Country:US
Mailing Address - Phone:956-447-9797
Mailing Address - Fax:956-447-9696
Practice Address - Street 1:1315 E 6TH ST
Practice Address - Street 2:STE. 10
Practice Address - City:WESLACO
Practice Address - State:TX
Practice Address - Zip Code:78596-4200
Practice Address - Country:US
Practice Address - Phone:956-447-9797
Practice Address - Fax:956-447-9696
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2019-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM0253207X00000X, 207XX0005X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XX0005XAllopathic & Osteopathic PhysiciansOrthopaedic SurgerySports Medicine
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX183393102Medicaid
TX183393101Medicaid
TX183393102Medicaid
TX384977ZLN3Medicare PIN